Vermont - IE&E Modernization Update

 

IE&E Modernization Update     VT-IES Project Update Vermont submitted the VT-IES RFP to CMS/FNS for review on September 15. VT-IES will consist of a Customer Portal, Case Management, and a Rules Engine, replacing legacy enrollment systems and optimizing eligibility, enrollment, and customer management functionality. Vermont expects vendors to propose an implementation approach that delivers timely and incremental release of improvements. Vermont has updated its list of mandated technologies it expects a vendor's solution to integrate with to support end-to-end integration.   Find Out More: VT-IES Project   Noticing Project Update Vermont released an RFP in June 2023 to solicit bids to integrate with Hyland's Content Composer as the foundational noticing solution for the IE&E Program.  Vermont recognizes that alternate vendor solutions should be considered. Vermont has decided not to award a contract based on the June 2023 RFP. Vermont will open a new competitive procurement that does not mandate a preferred noticing technology and simplifies the desired integration approach. The future noticing solution will have an integration with VT-IES.   Vermont IE&E was at ISM! Vermont's IE&E Program had 17 staff from the Agency of Humans Services and the Agency of Digital Services attend the ISM Conference in Kissimmee last month. We appreciate your support of this event. Vermont's IE&E Program Director was invited to present to the Human Services IT Advisory Group (www.hsitag.org). This presentation is available on YouTube; please click www.youtube.com/watch?v=PnuE0QUtEtY&t=691s   You can learn more about our IE&E Program by visiting  Integrated Eligibility and Enrollment (IE&E) System | Agency of Human Services (vermont.gov).   Join our Mailing List for MMIS & IE&E Updates

Vermont posts two RFP - Analytics Data Warehouse (ADW) and Security as a Service (SECaaS)

The State of Vermont is excited to announce the posting of two RFPs

• RFP Medicaid Analytics Data Warehouse Solution
• RFP Security as a Service (SECaaS) Vendor

Be sure to tell your friends and family.   

Thanks. 

Vermont's 2023 - Pre-MESC Update

 

We’re only days away from the 2023 Medicaid Enterprise System Conference (MESC) and we know you’ve been anxiously awaiting Vermont’s annual pre-conference communication.   This allows us to maximize the opportunities at MESC, to further build relationships, gain additional information, and increase awareness about industry standards, best practices, and lessons learned. 

 

Vermont continues to move forward with transforming its Medicaid Enterprise and serving Vermonters in the most time efficient, secure and integrated manner.  Vermont has five Centers for Medicare and Medicaid Services (CMS) Certified modules:  Health Information Exchange (HIE) (Vermont Information Technology Leaders (VITL)), Electronic Visit Verification (EVV) (Gainwell & Sandata), Pharmacy Benefit Management (PBM), (Change Healthcare), Care Management module (Acentra Health (formerly Kepro (formerly eQHealth))), and Provider Management Module (PMM) (Gainwell Technologies).  Vermont is leveraging the expertise of our Independent Verification and Validation (IV&V) vendor (CSG Government Solutions) as we continue our Medicaid Enterprise transformation. 

Regarding Vermont’s Enterprise:

v  Medicaid Management Information System (MMIS) Program:  

o   Note-1:  Medicaid Data Lake and Analytic Solution (MDLAS) procurement was awarded to Deloitte and executed in July 2023.

o   Note-2:  Vermont will be releasing a Request for Proposals (RFP) for an Analytics Data Warehouse (ADW) to be implemented and will integrate with our MDLAS.  Be advised the ADW will be maintained by Vermont’s HIE. 

o   Note-3:  Vermont Medicaid is not a traditional Managed Care Organization (MCO), a traditional Accountable Care Organization (ACO), nor all Fee-for-Service.  Vermont runs a publicly operated PIHP (Prepaid Inpatient Health Plan) delivery model through its 1115 demonstration waiver.  One component of the PIHP delivery model is the ability to implement payment options available under a managed care delivery structure.  The Vermont Medicaid Next Generation ACO (VMNG ACO) payment model is a program for which a risk-bearing Accountable Care Organization (ACO) receives a prospective payment and assumes accountability for the costs and quality of care for prospectively attributed Medicaid members.  Therefore, Vermont must report encounter data for both traditional medical and Home and Community Based (HCBS) or Long-Term Services and Supports (LTSS) programs because encounter data doesn't fall into traditional reporting protocols.  

 

v  Vermont is interested in scheduling MMIS Core Solution Demonstrations. Context and expectations for those demonstrations follow below.

 

o   Vermont’s MMIS Core Claims reprocurement approach:

§  MMIS Procurement Assistance RFP:  Vermont will release an RFP for services to work with VT MMIS staff to deliver a cost-benefit analysis, roadmap, and an MMIS Claims and Fiscal Agent (FA) Services (MMIS & FA) RFP.  MMIS Procurement Assistance RFP to be released this calendar year.

§  MMIS & FA RFP:  The timing of this re-procurement is TBD. This MMIS & FA RFP will leverage NASPO with added details to address Vermont-specific needs. It's these specific needs (some identified further below) that we are interested in hearing at MESC about how vendor solutions can support them. 

o   Vermont wants to hear from MMIS solution vendors and see just how configurable your MMIS solution is for implementing Vermont-specific needs. We realize an hour can limit what can be covered but at a minimum SoV would set up time for vendors to cover the following: 

§  Your current “go-to-market” solution:

·       What's it called and when was it CMS Certified?

·       Where are you actively implementing this solution right now?

·       What is your average implementation time?

§  Show how configurable the system is for implementing any changes associated with Encounter claims for ACO or HCBS/LTSS programming (aka $0 paid claims)

§  Using the example above, show the system’s ability to receive encounter data from Medicaid enrolled and non-Medicaid enrolled providers focusing on how the system captures and displays key elements such as: 

§  Member

§  Service information – amount, duration, number delivered

§  Place of service

§  Dates of service

§  Social Determinants of Health (SDoH) data if provided.

§  Ability to use ‘shadow’ nature of the service – delivered but paid $0 because the provider is being paid differently (e.g., a bundled payment or a PMPM) but to capture a Would Have Paid amount, based on codes, so that we can track what the service would have otherwise cost, and do cost avoidance if necessary. 

§  If using claims to do this, then a way to allow these to travel down a different path than a regular Medicaid claim with all of the checks, edits and audits.

§  Ability to easily distinguish Medicaid / non-Medicaid in terms of services delivered in a program with mixed attribution – easily reported separately and together.

o   Benefit package flexibility

§  Ability to create programs with services via a configurable mechanism.

§  Ability to include / exclude benefits, services from the Medicaid Total Cost of Care

§  Ability to adjust attribution of members to programs.

§  Easier linking of members and providers to these different benefit packages and programs

§  Easy way to change rates for services with one-to-many relationships with different programs.

o   Financial module allowing for easier tracking of value-based purchasing arrangements with providers.

§  Bundles

§  PMPMs

§  Case rates, including tiers.

§  Special program payments

§  Review of Reimbursement Methodology – how flexible is your solution with regard to the procedures and adding codes to pay for new services such as housing.

o   Additional solution flexibility to address COVID-19 waiver, 1115 Waiver, and the upcoming unwind activities related to members and providers.

o   Ability to integrate with provider information, including demographics and patient population.

 

The following are additional details of other Vermont related efforts:

v  Integrated Eligibility and Enrollment (IE&E) Program:    

o   Vermont has engaged in multiple Requests for Information (RFI) to increase the collaboration and exchange of information with the vendor community. 

• Vermont’s IE&E Program Team is pursuing a “Prime” vendor to implement a "customer-focused" core system that includes a Customer Portal, Case Management, and Business Rules Engine while taking advantage – where possible – of existing technologies to meet our end-to-end customer experience needs. This effort is called the Vermont Integrated Eligibility System (VT-IES).
• The VT-IES (pronounced VEE-Ties) Project will optimize eligibility, enrollment, and benefits management functionality to allow Vermonters to apply for, receive, and manage health coverage and economic assistance benefits through a user-centric access point that is personalized, welcoming & comprehensive.

o   VT-IES is an integral component of Vermont’s IE&E System Modernization efforts and will work alongside the IE&E Noticing Project to simplify the process of applying for and managing healthcare and financial benefits for Vermonters.

o   The VT-IES Project is in the final stage of RFP development and is supported by NTT DATA. The RFP is slated for release during 4th calendar quarter of 2023.

o   For additional information on VT-IES, please visit Integrated Eligibility and Enrollment (IE&E) System | Agency of Human Services (vermont.gov)

v  Health Information Exchange (HIE) Program:

o   Has started various initiatives related to establishing Data Governance for AHS

o   Key stakeholders have met to discuss our modernization efforts and the future role HIE plays to address Social Determinants of Health (SDoH)

 

v  Systems Testing workgroup – as you may recall from last year, Vermont, with the support of NESCSO, has established this workgroup to discuss and review best practices for User Acceptance Testing, Section 508 Compliance, Testing Maturity, Testing Automation, and more.  The next System Testing workgroup meeting will be held September 21, 2023. If you are interested in joining, please sign up here.  (State and State partners only, please).   This workgroup has been working with TransformHHS (tHHS) on their workgroup page and State Health Dashboard (SHD).   If you have any questions, please contact Vermont’s Quality Testing Director, Renee Taylor, at renee.taylor@vermont.gov.

 

v  Certification workgroup – as you may recall from last year, Vermont, with the support of CMS, Shelley Dimick, Vermont’s Certification Director, has established a national Certification workgroup to support State Medicaid Agencies collaboration.  This workgroup shares best practices, lessons learned, and provides clarity related to CMS Certification policies and workflows.  Tuesday (8/22) morning, Shelley will be having an in-person S-TAG Certification meeting over breakfast at 8:30. If you are interested in joining this workgroup of if you have any questions, please contact Shelley at Shelley.Dimick@vermont.gov.

Vermont staff attending MESC include the following: 

 

 

We look forward to our interaction during MESC - safe travels and see you in Denver! 

State of Vermont Announces Release of Independent Verification and Validation (IV&V) Request for Proposals (RFP)

 

Good morning everyone and greetings from the great Green Mountain State!   

The State of Vermont, Agency of Human Services (AHS), Department of Vermont Health Access (DVHA) is excited to announce the posting of an Independent Verification and Validation (IV&V) Request for Proposals (RFP).   We are seeking to establish a contract with a vendor to provide IV&V services associated with the modernization of the State’s Medicaid Enterprise System (MES).

 

The RFP can be accessed at the following link:  http://www.vermontbusinessregistry.com/BidPreview.aspx?BidID=57122

              NOTE:  when accessing this web-page there are two links on this web-posting:

• 1State of Vermont IVV-QA RFP 03410-200-23.docx:       will open the RFP doc itself
• 'Independent Verification and Validation RFP 03410-200-23 Bi:   this is the bid response template and be advised we are currently having an issue with the link.

 

As a reminder, tell your family and friends of our blog (http://vermont-ahs-dvha.blogspot.com/)and twitter (@DVHAVermont) account to stay informed of what’s happening with our modernization efforts. 

 

Have a great day and weekend.

Vermont MMIS Update prior to MES Conference

 

Good morning and greetings from the Green Mountain State!                                         8/11/2022

 With the 2022 Medicaid Enterprise System Conference (MESC) just days away, Vermont is sending our annual pre-conference communication.   This allows us to maximize the opportunities at MESC, to further build relationships, gain additional information, and increase awareness about industry standards, best practices, and lessons learned. 

 Vermont continues to follow guidance from our Federal Partners and move forward with transforming our Medicaid Enterprise and serving Vermonters in the most time efficient, secure and integrated manner.   Over the past year, we achieved two more Centers for Medicare and Medicaid Services (CMS) Certifications, for Health Information Exchange (HIE) and Electronic Visit Verification (EVV).  This brings our total to five with the other modules being:  Pharmacy Benefit Management (PBM) (Change Healthcare), Care Management module (Kepro (formerly eQHealth)), and Provider Management Module (PMM) (Gainwell Technologies).  Vermont is leveraging the expertise of our Independent Verification and Validation (IV&V) vendor (CSG Government Solutions) and our Procurement and Technical Advisor (NTT Data) to validate our expectations and planning efforts and continue our progress on our Medicaid Enterprise transformation. 

Regarding Vermont’s Enterprise:

• Medicaid Management Information System (MMIS) Program:            
• Note-1:  Medicaid Data Lake and Analytic Solution (MDLAS) procurement remains an active procurement and we cannot discuss any aspect of that effort.
• Note-2:  Vermont is interested in scheduling MMIS Core Claims Processing Demonstrations and is expecting MMIS vendors to speak to the following items.   The state will hold vendors to no more than an hour.  Further details below regarding what the State is looking to see and hear regarding your MES/MMIS solution.
• Note-3:  Clarity on Vermont’s role as a public managed care entity.
• Vermont Medicaid does not contract with traditional Managed Care Organizations (MCOs), nor does Vermont operate in a purely Fee-for-Service model.  Vermont has a publicly operated non-risk Prepaid Inpatient Health Plan (PIHP) delivery model through its 1115 demonstration waiver, whereby the state acts as a public managed care entity.  One component of the PIHP delivery model is the ability to implement payment options available under a managed care delivery structure.  The Vermont Medicaid Next Generation Accountable Care Organization (VMNG ACO) payment model is a program for which a risk-bearing ACO receives a prospective payment and assumes accountability for the costs and quality of care for prospectively attributed Medicaid members.  Therefore, Vermont needs to report encounter data because payment is not contingent upon fee-for-service billing.
• For more than a decade, Vermont has engaged in ambitious Medicaid and multi-payer reform efforts, seeking to develop advanced alternative payment models for Medicaid services that provide incentives for care delivery reform and support value-based care.  In line with CMS’ State Medicaid Director’s Letter in 2020 that outlined a vision for value-based care opportunities in Medicaid, Vermont has a robust portfolio of Medicaid payment reform initiatives. Through the Health Care Payment Learning and Action Network, (HCP-LAN) CMS has established a framework and targets for states to move from traditional fee-for-service models to advanced alternative payment models with quality components. Vermont Medicaid is leading the nation with nearly 70% of Medicaid payments falling into an advanced alternative payment model arrangement.  As Vermont continues to modernize the Enterprise, systems and technology that support these policies and offer the flexibility to adapt, create, expand and evaluate programs beyond traditional fee-for-service arrangements will be key considerations.
• The Department of Vermont Health Access (DVHA), on behalf of the Agency of Human Services (AHS), administers the Medicaid Program.   The graphic below depicts the PIHP model and illustrates the role that DVHA plays for establishing relationships across State Agencies/Departments and contractors to deliver Medicaid services for Vermont’s members.  

 

• Below are some additional examples of what the state is looking to see and discuss.
• What aspects of our Medicaid program business model cause issues for your MES/MMIS?
• What aspects of our Medicaid program business model would be supported by your MES/MMIS?
• As you discuss functionality, explain if the functionality is part of your NASPO awarded offering (if applicable) or if this is new functionality not included in their NASPO claims/financial module scope
• Is your encounter engine able to stand-alone as a module and be integrated with our vendors solutions?
• Ability to receive encounter data (using the above example) from providers – both Medicaid enrolled and not – and capture the key elements we need such as: 
• Member
• Service information – amount, duration, number delivered
• Place of service
• Dates of service
• Social Determinates of Health (SdoH) data if provided
• Ability to capture a “Would Have Paid” amount reflecting what a service would have otherwise cost for informational purposes and cost avoidance when necessary. 
• Sometimes referred to as:  Zero-paid claim, Encounter claim, or a Shadow claim
• If using claims to do this, then a way to allow these to travel down a different path than a regular Medicaid claim with all of the checks, edits and audits
• Ability to easily distinguish Medicaid / non-Medicaid in terms of services delivered in a program with mixed attribution – easily reported separately and together
• Benefit package flexibility
• Ability to create programs with services via a configurable mechanism
• Who (State, vendor) typically does this work and what role (BA, Tech, etc.)?
• Ability to include / exclude benefits, services from the Medicaid Total Cost of Care
• Ability to adjust attribution of members to programs
• Easier linking of members and providers to these different benefit packages and programs
• Easy way to change rates in the system for services with one-to-many relationships with different programs
• Ability to adjudicate claims funded by multiple federal and state funding sources per hierarchy established by federal and state payor of last resort regulation
• Updated Financial module that allows for easier tracking of value-based purchasing arrangements with providers
• Bundles
• PMPMs
• Case rates, including tiers
• Special program payments
• Review of Reimbursement Methodology – how flexible is your solution with regard to the procedures and adding codes to pay for new services such as housing or fuel
• Additional solution flexibility to address COVID-19 waiver, 1115 Waiver, and the upcoming unwinding activities related to members and providers

 

• Integrated Eligibility and Enrollment (IE&E) Program:              
• Vermont has a number of IE&E efforts that will result in procurement opportunities.  The next effort will be a Request for Proposals (RFP) for addressing noticing needs for the Agency of Human Services (AHS)

• Health Information Exchange (HIE) Program:
• Has started various initiatives related to establishing Data Governance for AHS
• Key stakeholders have met to discuss our modernization efforts and the future role HIE plays to address SdoH

 

We look forward to engaging attendees and discussing your creative visions and new ideas as we continue the build out of our Medicaid Enterprise.  We are looking for experienced and proven partners that are innovators and visionaries.  We want to hear where you recently have been implementing solutions and we are interested in learning more about sharing and integrating technologies/capabilities across our programs.  We want to know the good and the challenging aspects you’ve encountered.  As identified in CMS’ Seven Standards and Conditions, we desire solutions, services and components that are flexible, scalable and can be leveraged/shared across boundaries.   

Vermont staff attending MESC include the following: 

 

Vermont announces posting of Medicaid Data Lake and Analytic Solutions (MDLAS) Request for Proposal (RFP)

 

Good afternoon everyone and greetings from the great Green Mountain State.

Vermont’s Agency of Digital Services (ADS), the Agency of Human Services (AHS), and the Department of Vermont Health Access (DVHA) are excited to announce the posting of a Request for Proposal (RFP) to contract for Vermont’s Medicaid Data Lake and Analytic Solutions (MDLAS).   This is part of the State’s larger effort for our Medicaid Data Warehouse and Analytic Solution (MDWAS).    This RFP is located at:  Department of Buildings & General Services (state.vt.us).

 

Have a great day.   Stay warm!

 

Thanks